In what might be a first, a young child with hepatitis C has been cured of the virus following a liver transplant, thanks to new antiviral therapy. The delicate operation, in association with the pharmaceutical protocol, was performed at IRCCS-ISMETT, in Palermo, by a team led by Professor Jean de Ville de Goyet on a soon-to-be 2-year-old Ukrainian girl.
Milana was born with biliary atresia, a condition that causes the obstruction of the biliary ducts, and eventually developed end-stage liver disease. In Ukraine, where she was initially treated, she also contracted the hepatitis C virus, likely after a blood transfusion. She was therefore suffering from two conditions, biliary atresia and hepatitis C, which had compromised her health. The association of these two diseases in a child is very rare, and considered a contraindication for liver transplantation, the only possible treatment for her end-stage liver disease. “The hepatitis C virus has a very slow progression in children, and it some cases it regresses spontaneously,” said Professor de Ville de Goyet. “Usually, we monitor the child and wait for the regression or for the right age to start the pharmacological treatment. The situation changes when a transplant is needed at an early age. In this case, the disease progression was very fast and we could have risked losing the newly transplanted organ.”
The young girl received a living-related liver transplant, thanks to her mother, who donated a part of her liver, and then underwent an experimental protocol to treat her with a new antiviral therapy in order to defeat the hepatitis C virus. The transplant was performed in April, after which the therapy was started. “The case of our very young patient is, to the best of our knowledge, the first case of a pediatric transplant patient undergoing treatment for HCV with these new drugs,” continued de Ville de Goyet. “It should also be underlined that this is a pioneering treatment even outside the field of transplantation. Milana is, at present, the youngest patient ever to receive treatment with ledipasvir+sofosbuvir, regardless of the transplant. We believe, therefore, that this could pave the way for the use, on a larger scale, of these new drugs also in children, thus improving their life expectancy.”
Milana arrived in Palermo thanks to the solidarity of some patient associations and Ukrainian citizens who offered to help. “We’ve had great donors,” said Olga, Milana’s mother, “but also ordinary people that helped by giving what they could. Their generosity allowed us to travel to Italy and help my daughter.” Before Palermo, Olga had consulted other transplant centers in Poland and Belgium. “In Poland, they told me that there was no cure for hepatitis C to treat such young patients,” she said. Hence, the choice to contact ISMETT and travel to Italy. “I met a woman whose son had been transplanted by Dr. de Ville de Goyet, so I tried to get in contact with him. I found his e-mail address, and here we are.” Milana is now doing well, her liver works perfectly, and there is no trace of the virus in her body. “Milana,” says her mother, “is now eating everything, she sleeps all night, and plays with her brother. She has returned to being a normal 2-year-old.”